Community attitudes and mental health law

Abstract

Laws are codified expressions of community attitudes and values dominant in a particular socio-historical context. However, it is important to question whose attitudes are actually reflected by existing mental health legislation and how closely community attitudes and mental health law correspond. The purpose of this research was to explore both theoretical and empirical aspects of the relationship between community attitudes, mental health law, and the rights of mentally disabled persons. More specifically, the objectives were: to review the extent to which the rights of mentally disabled persons are protected by Canadian legislation, to provide recent survey data on community attitudes, to comment on the utility of legal reform as a means of changing community attitudes and mental health practice, and to assess the implications of the Canadian Charter of Rights and Freedoms (1982) for the social and therapeutic rights of mentally disabled persons. This analysis is restricted to civil legislation and deals with both the social and democratic rights of mentally disabled persons 1iving in the community and the therapeutic and civil rights of patients being treated in psychiatric hospitals. The data on community attitudes and mental health legislation in Manitoba were collected in the 1986 Winnipeg Area Study (WAS), which is an annual cross-sectional survey of Winnipeg residents. A random sample of 750 addresses was selected for personal interviewing from a computerized list compiled by the City Planning Department. The household was the primary sampling unit and gender, age, and residency were the selection criteria used to choose a respondent within each household. Data collection was carried out in 1986 and a total of 548 Winnipeg residents were interviewed (i.e., a response rate of 74%). The sample is quite representative of the general population of the City of Winnipeg. A scale was developed to measure community attitudes toward mental health legal issues such as the right of mentally disabled persons to perform social roles (e.g., work) and the right of psychiatric patients to have access to the benefits of due process. A number of potential correlates of community attitudes were investigated: sociodemographic characteristics, personal knowledge/experience with mental health problems and treatment facilities, and beliefs about the nature of mental illness and community mental health services. The overall picture which emerged from the data was that community attitudes toward the social and democratic rights of mentally disabled persons are quite divergent. There was greater consensus in the attitudes displayed toward the civil and therapeutic rights of psychiatric patients. For example, the majority of respondents felt psychiatric patients should have the right to benefit from the legal safeguards provided by due process. It should be noted that community attitudes were, for the most part, considerably more liberal than the existing mental health legislation in Manitoba. The predictors of community attitudes investigated in this study leave a great deal of variance unexplained. Beliefs about the nature and origin of mental illness and the therapeutic value of community care were the most significant correlates of attitudes toward mental health law. Experience with mentally disabled persons and respondent characteristics played a less important part.